Provider Demographics
NPI:1033114194
Name:UNTERMAN, MICHAEL IRWIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:IRWIN
Last Name:UNTERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:IRWIN
Other - Last Name:UNTERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:121 W RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-4335
Mailing Address - Country:US
Mailing Address - Phone:732-757-2385
Mailing Address - Fax:732-280-2107
Practice Address - Street 1:121 W RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-4335
Practice Address - Country:US
Practice Address - Phone:732-757-2385
Practice Address - Fax:732-280-5479
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA042154002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE72169Medicare UPIN
NJ199677Medicare PIN